Annual Health Insurance Resets

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What are extras limits?

What does it mean when my private health insurance limits reset?

Do my health insurance limits reset if I change funds?

How can I make the most of my extras limits each year?

Where can I find and compare health insurance?

Long story short

Your extras limits are limits on how much you can claim back on extras services

These can vary depending on your policy and the service you’re looking to claim for.

Your annual extras limits reset every 12 months

How insurers measure those 12 months can be different. It might be from 1 January, 1 July, or even from the day you joined up.

Your policy limits could help you figure out whether you’re getting value from your policy

If you hit the limits well before 12 months are up, you might need more cover. If you never get near the limits, you might want less.

What are extras limits? 

Your annual extras cover limits are the thresholds for how much you get back on services each year. For instance, if you have a $750 limit for dental, you can only get up to $750 back all up, until your limits reset for the new year. You might be able to use a service multiple times before you hit your limit, or one visit could be all it takes. 

Extras limits come in a few different shapes and sizes, including: 

Combined limits

Also called membership limits, these are limits you share with everyone on your policy. So, if your membership limit is $2,000, and you claim back $500 while your partner claims back $1,500, you’d have reached the limit, despite neither of you independently claiming $2,000.

Sub-limits

Your extras policy might list a range of services under larger umbrella terms, like massages nesting under natural therapies. If you had a $1,000 annual limit on natural therapies but a $500 sub-limit on massages, you could only claim up to $500 for massages. You’d then have another $500 left on your natural therapies limit.

Lifetime limits

Your limits for certain extras might not reset every year. In fact, they might never reset. This can mean you need to think carefully about what you claim for under this type of extra.

Depending on your policy, you might have to get familiar with and track a mix of limits to avoid being caught out when you go to claim.

What does it mean when my private health insurance limits reset? 

When your limits reset, you’ve got a clean slate to start claiming again.  

Depending on your private health insurer, your annual limits will reset every calendar year, financial year, or on the anniversary of your membership. For instance, Bupa and GMHBA both use the calendar year, with limits resetting on 1 January, while ahm and Peoplecare use the financial calendar, so their members’ limits reset on 1 July. 

FYI, it’s not just your extras limits that reset every year. Your hospital excess and co-payments do too.¹For more information, visit Australian Competition and Consumer Commission – Private health insurance This means that, after these limits reset, the next time you visit the hospital and use your private health insurance, you’ll need to pay your excess and co-payments again.  

However, you can use your health insurance at the hospital as much as you like for the next 12 months before you need to worry about paying your excess again. (Although we hope you don’t need to visit the hospital all that much in a year!) 

Do my health insurance limits reset if I change funds?

If you’re swapping health insurance, your health insurance limits might not reset. Instead, whatever you’ve claimed that year might follow you to your new policy, even if you change insurer. 

For example, if you’ve already claimed $500 for optical extras, like for a trendy new pair of glasses, but you change to a policy with an $800 optical limit, you might only have $300 left to play with until the limits on your new policy reset. 

It’s the same scenario if you change health insurance and have already claimed against any lifetime limits. When they say lifetime, they really mean it.  

Helpful tip:

When you’re comparing health insurance policies you might remember to look at the big-ticket items like what is covered and what your premium will be. However, checking what the limits are – and when they reset – could help you avoid a bigger bill than expected when you go to claim on your fresh health insurance policy.

Andres Gutierrez

General Manager – Health

How can I make the most of my extras limits each year?

Unfortunately, your extras limits usually don’t roll over. So, it’s time to carpe diem (that’s ‘seize the day’) and make the most of them when you can. 

• Claim sooner rather than later. It’s an obvious one, but if you want to get value from your extras, you need to use them, and that means putting in your claim. Don’t let those receipts languish in the car or the bottom of your handbag; send them in ASAP.
• Schedule your treatments around when your limits reset. Get organised and plan out when you’ll use your extras. You can even speak with the service provider beforehand to get quotes to help you plan out what’s possible before you hit the limit.
• Think preventatively. While you can’t reset your health, the next best thing is to be proactive. An appointment today could mean avoiding lots of expensive treatments tomorrow (or a bit further off in your future).
• Know what you’re covered for. It’s easy to just remember the key extras you use, but you could be paying for lots more. Dive into your policy and see if there are other claims you could be making.
• Regularly check your policy. While you’ve got your policy close to hand, take the time to review it thoroughly. Think about whether you’re roughly using up to your limits or regularly going way under or over. Your fund’s app may even show how you’re tracking on any given limit. If you aren’t getting anywhere close to the limit for a service, you may want to lower your cover. Alternatively, if you always seem to be hitting the limit long before the 12 months are up, you may want to get more cover for that service. Just remember that you might need to re-serve your waiting periods depending on the policy you switch to. 

Where can I find and compare health insurance?

If no amount of resetting is seeing you find joy with your extras, it might be time to start comparing health insurance. Luckily, iSelect is here to make things easy. You can use our online comparison tool or call one of our health comparison experts on 1800 784 772 today.